The Impacts of Bladder Cancer on UK Healthcare Costs and Patients' Health-Related Quality of Life: Evidence from the BOXIT Trial:Bladder cancer cost and health-related impacts

Background: Limited evidence exists regarding the cost and health-related quality of life (HRQoL) impacts of non-muscle invasive bladder cancer (NMIBC) recurrence and progression to muscle invasive bladder cancer (MIBC). We examined these impacts using evidence from a recent randomised control trial. Material and Methods: Costs and HRQoL associated with bladder cancer were assessed using data from the Bladder COX-2 Inhibition Trial (BOXIT) (n=472). Cost and HRQoL impacts from clinical events were estimated using generalised estimating equations. Costs were derived from recorded resource usage and UK unit costs. HRQoL was assessed using the EQ-5D-3L with published UK preference tariffs. Events were categorised by TMN classification. Results: Grade 3 recurrences and progressions were associated with statistically significant -0.08 (95% confidence interval -0.13, -0.03) and -0.10 (-0.17, -0.03) HRQoL decrements, respectively. The three year average cost per NMIBC patient was estimated at £8,735 (£8,325, £9,145) with grade 1, 2 and 3 recurrences associated with annual cost impacts of £1,218 (£403, £2033), £1,677 (£920, £2433) and £3,957 (£2,332, £5,583), respectively, and £5,407 (£2,663, £8,152) for a progression to MIBC. Conclusion: Evidence from the BOXIT trial suggests NMIBC patients will incur both decrements in HRQoL and significant costs, especially in the event of a grade 3 recurrence or a progression to MIBC.